Students, residents, and educators writing on KevinMD about how physicians are made: medical school, the match, residency, duty hours, supervision, assessment, mistreatment, and the path from student to practicing physician. Many contributors write while still in training, and many write anonymously. For a maintained record of what students and physicians have said about medical school since 2004, see Medical school: what students and physicians say, in their own words. For what residents and attendings have said about residency itself, see Residency: what residents and attendings say, in their own words.
Had I met her anywhere but the hospital, I would have gone to her side. I would have asked her what was wrong. I would have offered to help.
She was 99-years-old and about to undergo surgery. Pre-operative holding is generally a busy place. Patients lie in gurneys, spending some last moments with loved ones and fielding questions from various players of the surgical team as they come to the bedside. No, …
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Had I met her anywhere but the hospital, I would have helped her
We have been training physicians the same way for a century, ever since the famous Flexner Report of 1910. That report was commissioned by the Carnegie Foundation in an attempt to improve medical education. Up until then many medical schools were simply terrible. Many were proprietary schools, owned by doctors and run for profit rather than education. Many doctors met their first actual patient after they graduated.
During the decade following Flexner report these proprietary …
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Should medical school be shortened by a year?
“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of …
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Medical students may find themselves without a job
“What do you think, Doctor?”
For a novice physician, these worlds can quickly jolt a relatively straightforward conversation into a jumble of partially formed thoughts, suppositions, jargon, and (sometimes) incoherent ramblings. Even for simpler questions, the fumbling trainee does not have a convenient script that has been refined through years of recitation. Thus, many conversations that residents have with patients are truly occurring for the first time. And unfortunately, this novelty …
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How do we empower patients with information while not scaring them?
In July, I began an exciting role at Einstein: assistant dean for educational informatics. One of my main objectives is to optimize the use of technology to advance and deepen learning. But as much as I welcome it, technology alone will not achieve our educational goals.
Recently, David J. Hefland, the president and vice chancellor of Canada’s Quest University, characterized the model of contemporary education as “students as empty vessels that must be …
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Technology should not define medical education
On my second day of fourth year, I had to make a decision.
“Mr. K would like Miralax,” read the nurse’s page.
A medical sub-internship, which a student completes in her fourth year, is designed to be an internship with training wheels. The main difference between third and fourth year is that the third year reports to an intern (who makes a decision) while the fourth year replaces the intern. Last year …
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Sub-internship: The small stones are under my guardianship
There is a saying that you enter medical school wanting to help people but exit it wanting to help yourself. It may be a cynical view, but a realistic one. The criteria for being a good medical student are far different from being a good doctor. Medical education may be breeding a legion of self-serving, grade-grubbing, SOAP-note spewing machines rather than …
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Being a good medical student doesn’t mean you’ll be a good doctor
The discourse on the problems of the modern healthcare system contains much vitriol and blame. There is a distinct flavor of adversarial combat in the discussion; pitting physicians, those in the trenches, with those politicians and lawmakers on the other side. With estimates of healthcare costs exceeding 15% of the gross domestic product of the United States, it is easy to understand the passion that the topic evokes. The complexity …
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EMRs make it easier to just order the test
Medicine offers you a front-row seat on life. Meaning is all around you. When you can see it, it gives you a sense of gratitude for the opportunity to do this work.
-Rachel Naomi Remen
The first-year medical student cried openly during the session. Not hard, but enough to be embarrassed.
“I’m really sorry,” she said, “but this is one of the things that scares me most about going into medicine. I cry …
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It is perfectly fine to be emotional in front of patients
Discussions of resident duty hour reforms reached the point of ad nauseam a few years ago. Everyone had their say — program directors (“In 2003 we instituted an 80 hour work week, in 2011 we switched to 16 hour shifts, what’s next – online residencies!?”), senior residents (“What? I have to write H&Ps again? I don’t even know my computer password!”), interns (“I thought I was done with cross-covering after this …
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The fallacy of the current resident duty hour rules
I don’t have time for this, I thought as I attempted to walk the twenty minutes from home to my Mind-Body Medicine class at a ten minute pace. I felt a sharp cramp in my abdomen, reminding me that I had just wolfed down dinner without taking a break for enjoyment or digestion. By the time I reached the medical school building the sky was dark, my face glistened with …
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Our wellbeing is tied to that of our patients
My introduction to internship was during my hooding ceremony at graduation when the revered Dr. David Wagner hooded me and told me that internship was a time to become “intimate with disease and the suffering caused.”
“You will live with it so that it becomes so much a part of you that you instinctively know what to do, what to expect, even without sleep, food or outside contact.”
Filled up with this …
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6 tips for women physicians just starting internship
After getting off a 15 hour call day, all I want to do is write.
These past 2 weeks death has been on my mind a lot, more than it ever has been. I have always known that physicians counsel patients and families on dying, but actually being the one to do it is entirely different.
How do you tell someone that their best medical option, the best thing you can offer …
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The price for improvement sometimes outweighs the benefits
It was a quarter past six in the evening. The day team had just completed their signout to us. As we sat quietly along the periphery of the trauma bay getting oriented to our list of patients, a small army of hospital personnel started trickling in. We were expecting company.
He was rolled into the first slot. From behind the desk, I tried assessing how serious the injuries were, but the …
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As I held this man’s icy hand, my paradigm shifted
You have to love the blogosphere. The latest big issue concerns lower ABIM pass rates. Here are a series of blog posts worth considering.
Dumber Doctors?
One concern that has a ring of truth to it is that young doctors have become great “looker-uppers,” and have lost the sense of what it’s like to actually read and study medicine. While doctors enter the profession with a commitment to lifelong learning, …
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Don’t blame millennials for the drop in board exam pass rates
